What do you do when a patient threatens harm?

OrganizedChaos, LVN · Jan 27, 2018

It's amazing who is allowed to protect themselves and who isn't. Stranger accosting you on the street -- you're allowed to protect yourself. Husband threatening you with a knife -- you're as likely to go to prison for shooting him as you are to go to heaven for not shooting him. Patient threatening you in a hospital? No one goes to jail, but often someone loses their job.

It's complete & utter bs.

But I'd much rather lose my job than my life.

brownbook · Jan 27, 2018

In many years working in nursing homes with dementia patients, and in jails and psych wards, adult and juvenile, acute and chronic, no one has ever threatened me. Honestly, I am wondering about your approach to patients if you are getting what sounds like many threats.

My thoughts exactly. Although I did have a young female patient grab a finger nail file and point it at me in a threatening manner. I just stepped away from the bed. Another time a patient started to escalate when he claimed we lost his glasses. There were several male and female co-workers close by and he backed down.

I have taken a few self defense classes over the years but as we all know, if you don't use it you lose it. I think being aware of your surroundings is the best proactive defense. I do this when out in the public but I don't think about it at work.

Unfortunately I start looking for exit signs in church, theater, crowded areas, etc....thinking what would I do if someone started shooting.

These are my whole two incidences after 32 years of nursing.

quiltynurse56, LPN, LVN · Jan 27, 2018

Sounds like you handled this situation well. Sometimes a little empathy goes a long ways. Elderly with thin skin is fragile skin as you know. You did a good job there.

For those wondering about the patients where she works, I worked LTC and Rehab for a few months and I tell you, those rehab patients were some of the rudest people I have ever had to care for. I am sure they were the same way in the hospital when they came to us.

allnurses Guide · Jan 28, 2018

True. It would probably be best to take some kind of martial arts.

Yep, except most of what I've learned can't or shouldn't be used against a patient, lol. But with practice you (I) know what we can do or how to do just enough to defend without going too far.

My first CPI course taught a variety of HopKiDo techniques, but without frequent practice as said above, they are worthless. But my course was only 4 hours, not 16. I objected, but was told that was the class. My most recent class had security telling us not to try use those kinds of techniques, and refused to teach them, for that very reason. Our class emphasized recognizing a potential situation, keeping a clear path to the door, body posture and language to deescalate instead of provoke, etc.

OrganizedChaos, LVN · Jan 28, 2018

Sounds like you handled this situation well. Sometimes a little empathy goes a long ways. Elderly with thin skin is fragile skin as you know. You did a good job there.
For those wondering about the patients where she works, I worked LTC and Rehab for a few months and I tell you, those rehab patients were some of the rudest people I have ever had to care for. I am sure they were the same way in the hospital when they came to us.

Thank you. I swear, patients (& family members) are just getting rider & ruder!

OrganizedChaos, LVN · Jan 28, 2018

Yep, except most of what I've learned can't or shouldn't be used against a patient, lol. But with practice you (I) know what we can do or how to do just enough to defend without going too far.
My first CPI course taught a variety of HopKiDo techniques, but without frequent practice as said above, they are worthless. But my course was only 4 hours, not 16. I objected, but was told that was the class. My most recent class had security telling us not to try use those kinds of techniques, and refused to teach them, for that very reason. Our class emphasized recognizing a potential situation, keeping a clear path to the door, body posture and language to deescalate instead of provoke, etc.

But why shouldn't they be used against a patient? If a patient truly is attacking me, why shouldn't I be able to fight back? Don't we all want to go home?

If I have self defense training & I need to protect myself before security gets there because I'm on the 8th floor, I'm gonna use it. If I don't because the hospital told me no, you bet your sweet behind if I get hurt by the patient I will sue that hospital for everything! I'm not getting hazard pay & there is nothing in my contract about hazard duty.

allnurses Guide · Jan 28, 2018

But why shouldn't they be used against a patient? If a patient truly is attacking me, why shouldn't I be able to fight back? Don't we all want to go home?
If I have self defense training & I need to protect myself before security gets there because I'm on the 8th floor, I'm gonna use it. If I don't because the hospital told me no, you bet your sweet behind if I get hurt by the patient I will sue that hospital for everything! I'm not getting hazard pay & there is nothing in my contract about hazard duty.

LOL, I said most of what I learned: stick fighting, sparring, some really nasty ways to take out an attacker. Yes, I know how to kill, because we have to learn what not to do in order not to kill.

I have used, as Hppy has, hand or arm hold techniques several times. Security guard looked at me and said "I didn't know you knew how to do that!". I prevented a serious attack on a co-worker by putting a person to the floor, (right in front of people from my church who happened to be there as patients, go preacher's wife!!).

It is knowing which part of your defense training to use, and not to go beyond what is necessary for protection, is what I meant. The CPI taught some techniques but they are just as likely to backfire if you don't practice regularly.

I still have a small scar from being bitten, went to the Grand Jury on that one. She got 2 felony count convictions for battery on a health care worker.

FolksBtrippin, BSN, RN · Jan 31, 2018

If a patient threatens violence when you are giving care, you need to stop what you are doing and assess.

Consider whether the patient is refusing care, which is their right. "I'll punch you in the face" is an extreme way of saying "No." Is this happening because of pain? Anxiety? Assess for other causes or contributing factors like confusion, dementia, lack of sleep, privacy, cultural barriers, need for education.

Some interventions would be letting patents take off their own tape, administering prns, etc.

guest940422 · Feb 1, 2018

The ANA has an Advacacy Panal specifically adressing the issue of violence towards nurses in the workplace. They also have been doing research on unit bullying prevention, and changing the acceptance culture.

They have an E-book on the website that is really good called Not Part of the Job: How to Take a Stand Against Violence in the Work Setting its $28 for ANA members and $33 for non-members. eBook - Not Part of the Job: How to Take a Stand Against Violence in the Work Setting

They also have a lot of good resources and articles. It's really important that we stop accepting abuse as a byproduct of working in healthcare, and we take a unified stance against it. The ANA is also lobbying to make assault against a healthcare worker a felony offence (just like a police officer or first responder). It doesn't cost that much to join if you aren't a member and your membership dues are applied toward countless causes like this.

NurseVal93 · Feb 2, 2018

If de-escalation doesn't work then I assess their mental status. If they are pretty oriented and know what they are doing then I say "since you know what you are doing then I should inform you that hitting a nurse is considered a felony". I ususally get an apology afterwards and make sure to document that interaction. We let ourselves get abused too much.

Wait, how am I a nurse and did not know that hitting a nurse is considered a felony?

Is that in all 50 states?.. I am in CA.

bgxyrnf, MSN, RN · Feb 7, 2018

So far in my short few months on the floor I've already had a bunch of patients threaten to hit me. Every time I get threatened or yelled at by the public all I can think of is that I'm not getting paid enough to put up with this ****.
What do you do when someone just threatens violence? If I just called security on my ascom who knows when they would show up. But I don't feel the need to call a code since nothing is actually happening & I don't want to make the patient more irate.
Yesterday I was trying to remove a patient's IV (she was being D/C'd). She had paper thin skin & lots of tape. I was trying to go as slow as possible & use ETOH pads & then hand sanitizer. She wasn't good with pain & at one point she said she was going to punch me in the face. What do you do in a situation like that? I just quickly changed the conversation & de-escalated her, then she was fine.

I've been threatened a number of times, up to and including a threat by a patient to get a gun and hunt me down, as well as my family.

In the moment of being threatened, I immediately and forcefully reply that I will not tolerate such threats while immediately backing away and taking steps toward my personal defense. I then chart what happened and notify my supervisor. I then refuse to provide care for the patient without sufficient resources present to ensure my safety. If appropriate, I then contact law enforcement to report the threat.

The specifics of my response are completely dependent on the nature and credibility of the threat as well as my assessment of my personal risk.

Ambersmom, BSN, RN · Feb 8, 2018

I take it in the context of how they said it, their age, and ability to carry through on the threat. I am thankful to have had CPI training, and I firmly believe EVERY healthcare worker shoukd have CPI (crisis prevention intervention) training. It has definitely saved my butt on many occasions.